Breast Lumpectomy

Get Well Soon Helping you to make a speedy recovery after breast-conserving surgery

Contents Who this leaflet is for 2 What to expect after the operation 3 Things that will help you recover more quickly 5 Returning to work 7 Planning for your return 8

Driving 9 Recovery tracker 10 After you get home 14 Keeping well 16 Website links 17

This leaflet is a guide to recovering from lumpectomy of the breast. It does not provide specific medical advice or diagnosis, nor does it give advice about whether you should consent to an operation. All of these matters depend on individual medical advice from your consultant surgeon based on your own health, medical condition and personal circumstances. Get Well Soon Helping you to make a speedy recovery after lumpectomy

Who this leaflet is for This leaflet is for anyone who is recovering from, or who is about to undergo, Every individual has different needs and Print instructions: lumpectomy or breast-conserving surgery recovers in different ways – so not all for breast cancer. It should be read in the advice in this leaflet will be suitable To print this document click conjunction with any other information for everybody. This leaflet offers broad once on the print icon in your you have already been given about your guidelines for people who do not have Acrobat Browser, or go to File, procedure. any complications with their surgery, and then Print on the drop down whose job is not physically demanding. menu. The technical term for your breast operation is wide local excision. This Everyone who undergoes a lumpectomy To print only one page, select is how your surgeon and other health should have an allocated contact at the the page number you want in professionals who are helping you may hospital (a key-worker or breast care nurse your print menu, usually under refer to it. The operation involves removal specialist) who helps to coordinate all ‘options’ or ‘preferences’ of the lump or abnormal area and a small aspects of care. They will help you make depending on the printer type. amount of the normal tissue around it, the right choices for a safe and speedy whilst conserving the breast shape. When recovery. To save ink, select the ‘draft’ you have a lumpectomy, most women will option. usually be offered surgery to remove some Your surgeon, general practitioner (GP) or all of the lymph nodes in the armpit and other healthcare professionals will (axilla) on the same side. The extent of also offer you a lot of very good advice – your surgery will influence how quickly you but ultimately it’s you that has to make the recover. decisions about your care.

Most women undergo surgery followed Knowing what to expect after the by either radiotherapy, chemotherapy, operation can help you to make a quicker anti-hormone tablets or any combination recovery and get back to enjoying the best of these. After lumpectomy, almost all possible quality of life. In the pages that women with invasive breast cancer will follow, you’ll find information that will help be offered radiotherapy. Some studies you do that. A diagnosis of breast cancer have shown benefit in giving anti-hormone can provoke a wide range of feelings tablets or chemotherapy before surgery and emotions; these can be frightening to reduce the size of the lump, allowing it and difficult to deal with. This leaflet also to be more easily removed. However, your includes web-links to other sources of individual treatment plan will be discussed valuable information. at multidisciplinary team meetings with all the specialists involved in your care; they will make recommendations together and then discuss these treatment options with you. You may also be asked if you would like to take part in national clinical trials; these studies help researchers to develop better treatments and improve outcomes for patients in the future.

2 Get Well Soon Helping you to make a speedy recovery after lumpectomy

What to expect after the operation

There will be some variation both in the Stitches extent of each individual patient’s surgery Most lumpectomy scars have dissolvable Pain relief and their body’s response to it; patient stitches that do not need to be removed. Some painkillers, such as recovery programmes may therefore vary. However, if you have stitches that do those containing codeine, need to be removed, this is usually done may cause constipation, so Scar around 7–10 days after your operation by it’s important to get plenty Your scar will usually be discussed with a nurse in your own home, or by a nurse at of fibre in your diet while you you before your operation. It is normally your local clinic or treatment centre. Your are recovering. Fresh fruit and placed within the bra line so is not visible hospital should already have given you vegetables will help to keep when you are wearing clothes. Scars advice about how your wounds are closed your bowels moving regularly. may be raised, red or swollen at first, but and how to care for them. Lactulose may also be useful. should gradually settle and will fade over time. Discomfort Following a lumpectomy, tingling and Dressings mild pain around the scar are common After your operation, the scar will be complaints during the first few days. covered with a waterproof dressing. It Your surgeon may have put some local is wise to keep the dressing dry for the anaesthetic on your wound during surgery first 48 hours, then you may shower or so you may not have any pain initially; bathe as normal, but try not to soak the you will have been given some simple dressing. The scar will need to remain pain-relieving tablets while you are on the covered for 7–10 days. ward and also to take home. Remember to take them as prescribed, for as long as Wounds can weep a little and the dressing required. may need to be changed. If this is the case, or if you have any other wound At 4–6 weeks, the breast may still feel firm. problems, the ward staff, your local This is usually where the fat in your breast dressing clinic, or your breast care nurse has become hard; it is nothing to worry will be able to advise you on how to about and should settle and soften over manage this. time.

Once your dressing is removed, avoid rubbing soap or shower gel directly onto your wound. Pat the scar dry with a soft towel. Do not pick any scabs that form as they are protecting the new tissue growing underneath.

3 Get Well Soon Helping you to make a speedy recovery after lumpectomy

What to expect after the operation

Swelling or heaviness of the Feeling tired or emotional breast If you feel tired or emotional in the days In the first few weeks after surgery, and weeks after your operation, try not to sometimes clear or pink-stained fluid worry – this is a quite normal reaction that can collect under the skin as a swelling many women experience. A diagnosis of (seroma). You may also develop bruising; breast cancer can provoke a wide range this will slowly fade, although sometimes a of feelings and emotions; these can be hard, tense bruise can form (haematoma). frightening and difficult to deal with. Your breast care nurse specialist, surgeon and If either a seroma or a haematoma does GP will be able to offer you sources of develop, it can be uncomfortable and help and support. As your physical activity give you a heavy feeling in your breast. levels improve, you will steadily start to Both of these can be dealt with in a feel less tired and as time goes on you will straightforward way. Contact your breast feel less anxious. care nurse and she will be able to advise you; otherwise speak with your GP for further advice.

Hollowing After a lumpectomy, you may experience a hollowing under the skin where the tissue has been removed. This is often called a defect; it is not harmful but it may bother you. If you are concerned about it, speak with your breast care nurse or surgeon who will be able to advise you. Wearing clothes after a lumpectomy

When you go home you can wear a supportive, sports-style bra. You can also wear it at night if you find this more comfortable.

4 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Things that will help you recover more quickly

Eat healthily Keep a routine If you live alone and don’t A healthy balanced diet containing a Get up at your normal time in the morning, have family or friends living variety of foods, including plenty of fresh get dressed and move about. If you get close by, organise support in fruit and vegetables, will help to ensure tired, rest later. advance – if possible, have that your body has all of the nutrients it family or friends come to stay needs to heal. Exercises with you for the first couple of Your surgeon or breast care nurse may weeks after surgery. Stop smoking recommend shoulder exercises as part By not smoking – even if it’s just for the of your recovery; these will stop your time before your operation and while shoulder getting stiff. If so, it is important you’re recovering – you immediately start to continue these at home for as long to improve your circulation and breathing, as you are advised. It is possible that not to mention a whole list of other some patients may also need to receive benefits to the heart and lungs. additional outpatient physiotherapy follow- up. Family and friends Family and friends can give you two important things:

• Practical help - with the tasks you might temporarily be unable to do while you recover – such as driving, cleaning, the weekly shop or lifting heavier items.

• Emotional support – it is important to talk to your family and friends about how you feel. Sharing your concerns with close friends and family can help your recovery.

5 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Things that will help you recover more quickly

Preventing blood clots Measures to prevent clots in the leg need to be taken following lumpectomy, sometimes continuing for up to 6 weeks. A range of options is available and your surgeon will advise on what is best for you. A TED stocking is often used following the operation; either above- or below the knee.

Build up gradually Have a go at doing some of the things you’d normally do, but build up gradually. Obviously, everyone recovers at different speeds, so listen to what your body is telling you.

As you build up your activities, you may feel more tired than normal. If so, stop and rest until your strength returns. If you feel pain, you have probably just overdone it a little. Ease back and then gradually increase again. If you are concerned about anything, consult your GP or contact your breast care nurse.

6 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Returning to work

Fact: Work can be part of your How soon can I go back? You do not need your GP’s recovery There are no rules – every person recovers permission to go back to Everyone needs time off to recover after differently and has different needs. work – this is ultimately your an operation – but too much of it can decision, but listen to the stand in the way of you getting back After 1–2 weeks, you will return to the advice offered to you. to normal. Getting back to your normal clinic to see the surgeon and breast routine when you are physically and care nurse for your histology (cancer) emotionally ready for it can actually help results. You may need further surgery, you recover more quickly. radiotherapy, chemotherapy, anti-hormone treatment, or nothing more. What you Getting back to work need will influence how soon you can How quickly you return to work very much return to work. Some women choose to depends on a number of things: remain off work for the full duration of treatment. You may wish to try to do some • Whether you need further surgery work between treatments, or to visit work or other treatment, such as and keep in touch with your work friends radiotherapy or chemotherapy. and colleagues. This may help to maintain your confidence and make returning to • How you heal. work easier.

• How you respond to surgery. In the first instance, your surgeon and breast care nurse will help you work out • The type of job you do. what is right for you, and if your employer has an occupational health nurse or doctor, they will also be able to advise you. Alternatively, your GP can give you advice, but ultimately, it’s your decision when you decide to go back.

7 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Planning for your return

Talk with your Occupational Health Service • Doing work that is mostly paperwork, 3 golden rules for a or GP to work out when and how is best using a computer or telephone. speedy recovery: for you to return to work. It is best to see Stay active. your occupational health service once you • Not carrying more than around Keep a normal daily routine. have an idea of what your treatment plans 5 kg any significant distance. Keep social contact with are going to be, rather than waiting until people. all your treatment is finished. This allows • Avoiding tasks such as you to discuss all the options with them prolonged loading or unloading, and will help your employer plan for any packing or unpacking. adjustments that are needed while you recover. Cancer is considered a disability If you have an HR Department at under the Equality Act; employers work, they will be able to advise you Confidence therefore have a duty to make reasonable regarding sick pay or any other benefit It will take you a little while adjustments to help you return to work. you may be entitled to during your time to regain your full confidence off. Alternatively, talk directly with your when you go back to work. Depending on the nature of your job, employer. You may be slower than while you recover your full strength, you normal at first, so don’t take might want to ask your employer about on too much responsibility returning to work on lighter duties, working too soon. Don’t be too hard from home, or working shorter hours at on yourself about this - it’s first. Most employers will be happy to perfectly normal and you’ll accommodate your needs. Lighter duties start to get back up to speed might mean: after a few days. • Spending more time sitting, rather than standing for extended periods, or doing lots of walking.

8 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Driving

Your insurance company should be Notifying the Driver and Vehicle Ultimately, it is your informed about your operation. Some Licensing Agency (DVLA) responsibility to ensure that companies will not insure drivers for a After lumpectomy, you do not need to you are in control of the number of weeks after surgery, so it’s notify the DVLA. However, higher medical vehicle at all times and to feel important to check what your policy says. standards are required if you hold a Class confident that you would be 2 licence, so for reasons of safety and able to demonstrate this, if There are no hard and fast legal comfort, your doctor may advise some asked. rules about when you can drive after drivers to delay driving for a little longer. lumpectomy, and some patients may You should also speak with your employer. be fit to drive earlier than others. It is important to follow your doctor’s advice, and the views of your insurance provider. Your doctor’s decision will depend on a number of things including: wound care considerations, such as the position and extent of your wound, your personal health and medical condition, and your personal circumstances, such as whether you are a Group 1 (car or motor cycle) or Group 2 (bus or lorry) licence holder.

Before resuming driving, you should be comfortable in the driving position and able to control your car safely, including freely performing an emergency stop without damaging your operation wound. You will need to be fully recovered from your surgical procedure, and free from the distracting effect of pain, or the sedative or other effects of any pain-relief medication you may be taking, so that you can concentrate fully on driving.

It is advisable not to restart driving with a long journey.

9 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Recovery tracker

Days Post Op How you might feel Things you can do safely Traffic light Fit to work?

1–2 days You will normally leave hospital the • Get up, get dressed, move No same day, or the following morning. around. You will have mild pain at the site of • Eat and drink as normal. the scar. Find a comfortable non- • Do the shoulder exercises if you underwired, sports-style bra; you have been given them. can wear this at night too, to help • If you feel tired, rest for a while support the breast. and try moving around again later. You will feel more tired than normal. Take things easy.

3–7 days There should be less pain in and • Continue as days 1–2. No around your scar. • Try to go for a walk at least You’ll get tired more quickly than once a day. If you have a dog you did before the operation. and need to hold its lead, walking alone may be difficult if you have shoulder pain, or if you have had surgery to the armpit, so consider walking with a friend. • You may still occasionally need to take a mild painkiller at this time. • Check you do not have swelling or bruising at your wound site.

When can I have sex? specific print For many women, being instructions: able to have sex again is To print only this section of an important milestone in the document click once on their recovery. There are the print icon in your Acrobat no set rules or times about Browser, or go to File, then when it’s right to do so other Print on the drop down menu. than whether it feels OK to Then select pages 10 to 13 in you – treat it like any other your print menu, usually under physical activity and build up ‘options’ or ‘preferences’ gradually. depending on the printer type.

10 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Recovery tracker

Days/Weeks How you might feel Things you can do safely Traffic light Fit to work? Post Op

8–13 days You’ll probably be able to do most • Continue to build up the amount No things as normal most of the time, of activity you’re doing towards but you will still get tired. You might your normal levels and keep up start to feel anxious about your with the shoulder exercises if results appointment – this is normal. required. • Some women may want to try working from home at this point. Shoulder pain and armpit surgery may make it difficult to use a computer keyboard or even hold a telephone, so don’t try to do too much at this stage.

11 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Recovery tracker

Days/Weeks How you might feel Things you can do safely Traffic light Fit to work? Post Op

14+ days You should be feeling physically Keep up your shoulder exercises Thinking about it; many stronger each day. if you were asked to do them and women will be able keep up your walking. to return to work in a • You should have had your management or light follow-up appointment, administrative role at had your scar checked, got this stage, starting with your results back, and have reduced hours while they discussed your treatment plan settle in and regain fitness with your surgeon and breast and confidence. Shoulder care nurse. Most women are and arm symptoms may offered breast radiotherapy make it difficult to do some following lumpectomy, but not physical tasks, particularly always. heavy lifting or reaching. • If you require more surgery, You should discuss your surgeon will discuss what adjustments to duties with further surgery is needed and your employer if you wish when. to return to work now. • If you require radiotherapy, you will meet the specialist team and discuss your treatment. • If you require chemotherapy, you will be referred to the specialist teams for discussion about your treatment. Sometimes you may need both chemotherapy and radiotherapy. If this is the case, you will be given chemotherapy first. • If you require anti-hormone treatment only, or even no further treatment, you can discuss with your GP and employer about planning a return-to-work date.

12 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Recovery tracker

Days/Weeks How you might feel Things you can do safely Traffic light Fit to work? Post Op

6 weeks Check your shoulder and arm If you work, it’s your decision Yes; although a few women movements are back to normal; when you decide to go back, but may have problems with if you have a stiff shoulder you if you’re off for too long, there’s arm pain or swelling. They will need to contact your GP, a risk of developing problems to won’t be harmed by work breast care nurse or surgeon. You do with anxiety, isolation and lack but may have difficulties may need to be referred to the of confidence. These could affect reaching or with heavy physiotherapy team for additional your quality of life in the long-term. lifting. A temporary change help and exercises. Talk with your GP about how best to lighter physical work and to avoid this becoming a problem shorter hours can help. for you or have a chat with your occupational health doctor or nurse It is common to feel and employer about a gradual tired towards the end of return. radiotherapy treatment and for a few weeks afterwards. Consider working reduced hours or fewer days for this period.

13 Get Well Soon Helping you to make a speedy recovery after lumpectomy

After you get home

Day Got up Activities: How much What times Went to bed How have I been What do I want to at ... eg, shoulder exercises/ rest I needed I needed to at ... pm feeling? Any pain? achieve tomorrow? am walked for ... mins rest Emotional feelings?

Keeping a track of what specific print you’ve achieved each day instructions: will help you to stay positive To print only this section of and get back to enjoying your the document click once on normal life more quickly. the print icon in your Acrobat Browser, or go to File, then Print on the drop down menu. Then select pages 14 to 15 in your print menu, usually under ‘options’ or ‘preferences’ depending on the printer type.

14 Get Well Soon Helping you to make a speedy recovery after lumpectomy

After you get home

Remember, take a step-by- step approach to getting better, and build up your activities in small stages. Don’t push yourself too far too fast. If you’re concerned about anything, or if you feel you’re not making progress fast enough, ask your surgeon or call your GP.

15 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Keeping well

Because of your operation, the chances Holidays and travel are not a problem, are you’ll be a lot more aware of your body but it is important to delay them until and how it works. your wounds are healed and any other treatment is complete; bear in mind Right now is a really good time to build on radiotherapy and chemotherapy will the knowledge you’ve gained and make impact on travel plans. Check with your small changes to your lifestyle that can breast care nurse or doctor. prevent you from experiencing certain health problems in the future. You can do If you do travel in the weeks following this by: surgery, take sensible precautions: keep well hydrated, avoid alcohol, wear flight • Improving your diet – a healthy diet socks and try to keep as mobile as you contains a variety of foods, including can during flights. fresh fruit and vegetables, starchy foods (such as rice, pasta and If you are taking tamoxifen tablets as part potatoes) and some protein-rich foods of your treatment, these precautions are (such as meat, fish, eggs, lentils and particularly important. beans). A healthy diet is also low in fat (especially saturated fats), salt, and If you are planning a long-haul flight, sugar and limits alcohol consumption. take advice from your doctor or breast care nurse as you may well need to take • Any exercise – even if it’s just a few additional precautions. short walks each day – really will make a difference to your health. Travelling within the European Union is probably easier than elsewhere in the • Quit smoking - NHS Stop Smoking world, mainly because you can access Services are one of the most effective any emergency treatment that you need ways to stop for good – and they’re free. – provided that you have a European Your doctor will be happy to help you. Health Insurance Card (EHIC). However, it’s important to remember that this does not cover you for the cost of having to be Holidays and travel flown home under medical supervision Getting travel insurance following surgery after emergency treatment, which is an can sometimes be difficult, so it’s best expense you will have to cover yourself. to shop around for a good deal. The Also, the emergency cover provided is Macmillan website only to a level given to the people resident (http://www.macmillan.org.uk/) lists a in that country. number of companies that are prepared to offer insurance.

16 Get Well Soon Helping you to make a speedy recovery after lumpectomy

Website links

The internet’s a great thing – anything you Cancer Help provided by Cancer want to know is there for you at the click Research UK of a mouse, but do be careful about the http://www.cancerhelp.org.uk/ way you use it when it comes to getting information about your health. It’s hard NHS Stop Smoking Service to know which sites to trust and none of http://smokefree.nhs.uk/ them can tell you anything that’s specific to your individual medical needs. NHS Choices http://www.nhs.uk/Pages/Homepage.aspx If you do want to know more about your operation, recovery or return to work, here Department for Work and Pensions is a list of trusted websites that offer safe, https://www.gov.uk/government/ sensible, useful information: organisations/department-for-work- pensions Royal College of Surgeons of England http://www.rcseng.ac.uk/ GOV.UK https://www.gov.uk/ Association of Breast Surgery http://www.associationofbreastsurgery. DVLA - Driver and Vehicle Licensing org.uk/ Agency https://www.gov.uk/browse/driving/ Breast Cancer Care disability-health-condition http://www.breastcancercare.org.uk/ Call 111 for nonemergency medical advice Breast Cancer Campaign http://www.breastcancercampaign.org/

Breakthrough Breast Cancer http://www.breakthrough.org.uk/

Macmillan Cancer Support http://www.macmillan.org.uk/